Chemotherapy induced myelosuppression

To evaluate chemotherapy induced myelosuppression, its management and outcome.

Retrospective analysis of patients aged 13 years and above.

Hurlingham Oncology Clinic and the Nairobi Hospital during the period of June 1998 to June 2003.

Two hundred and two solid tumour and lymphoma patients treated with pulsed chemotherapy at Hurlingham Oncology Clinic and those treated by the same service at the Nairobi Hospital.

Two hundred patients were evaluable for nadir blood counts. World Health Organisation (WHO) grade 3 neutropaenia complicated 57 (26.1%), and grade 4 complicated 56 (25.7%) treatments. Grade 0 neutropaenia was seen in 40 (18.4%) treatments, 33 having included prophylactic Granulocyte-Colony Stimulating Factors (G-CSF). Neutropaenia was worst following the first and sixth courses, and repeated second line courses but the difference was not statistically significant (p = 0.154). Fever complicated 6 grade 3 and 21 grade 4 neutropenic episodes (23.1% of 117 evaluable). Twenty eight patients were hospitalised because of severe neutropaenia (23 febrile, and five afebrile initially but with absolute neutrophil counts < 0.01 x 10(9)/litre). Eight of them died, six attributable to infections (21.4% mortality) and two attributed to other causes. Median time to neutrophil recovery to 21.5 x 10(9)/litre was three days with a mean of 4.6 days. Anaemia and thrombocytopaenia were not commonly experienced.

Prophylactic use of G-CSF may have prevented severe neutropaenia and its use in severe neutropaenia may have reduced the duration and severity of neutropaenia but the mortality rate for febrile neutropaenia remained high.